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PT-10-292 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 136312 Permit Number: PT -2 -10 -292 Scheduled Inspection Date: March 09, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: SHUSHTAR, MOJDEH Work Classification: Addition /Alteration Job Address: 848 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132060050350 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 08, 2010 For Inspections please call: (305)762 -4949 Page 20 of 34 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 136312 Permit Number: PT -2 -10 -292 Scheduled Inspection Date: March 09, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: SHUSHTAR, MOJDEH Work Classification: Addition /Alteration Job Address: 848 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132060050350 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed E] Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 08, 2010 For Inspections please call: (305)762 -4949 Page 20 of 34 7 =11, 777 T44 1' t g Miami Shores Village PO W ■ a 10050 N.E. 2nd Avenue „ �I��r81�1fl •n� ��£fflfC 9 Miami Shores, FL 33138 -0000 " Phone: (305)795 -2204 ' 3 , f, N i'i'R VIA T 3 Expiration: 08 12 9 120 1 0 Project Address Parcel Number Applicant 848 91 Terrace 1132060050350 MOJDEH SHUSHTAR Miami Shores, FL 33138 Block: Lot: Owner Information Address Phone Cell MOJDEH SHUSHTAR 3928 GATEWAY Drive PHILADELPHIA PA 19145 - Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 HOME OWNER Total Sq Feet: 0 Type of Work: Exterior For Inspections please call: Color. (305)762 -4949 Additional Info: PAINT Available Inspections: Classification: Residential Inspection Type: Color. _Approved Code Comments: walls, soffit, chimney - beige / fasciz Final Color: _Approved_ Color: _Denied Fees Due Amount Invoice # Invoice Total Amt Paid Amt Due CCF $1.20 PT - - 10 - 37120 Education Surcharge $0.40 $63.20 $63.20 $0.00 Permit Fee $60.00 Technology Fee $1.60 Total: $63.20 Building Department Copy March 02, 2010 2 p . . Miami Shores Village Buildin f EB 2 4 701 Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Y: • • • • • .... 7d. (805) 795A204 1 $aecr ( 758 .897.2 BUILDING Permit No. S I PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type PAINT PERMIT / Owner's Name (Fee Simple Titleholder) a �Gtt� one # _? (p Owner's Address City ,?hAuP S State L Zip Tenant/Lessee N e ` Phone # M E -AIL• G` a 4'- 1/IA0 ® cl@ LLB' Job Address (where the work is being done) /qE ( rr City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name A) / A Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No OWNER BUILDER: AA a T, iia/Z , Value of Work For this Permit f � > Type of Work: El Addition / 2a►teration / ❑New / El Repair/Replace P Describe Work: / Ili Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Permit Fee $ o - ®� CCF $ d • Technology Fee: Training/Education Fee $_ Notary $ Code Enforcement $ Double Fee $ Zoning $ Total Fee Now Due $ • - zo See Reverse side —� IMialni Shores village .. Building Department 1 10050 N_1'.2nd Avenue_ Miami Shores. Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: PAINT PERMIT Owner's Name (Fee Simple Titleholder) Phone # Owner's Address City _______ State Zip Tenant /Lessee Name Phone # E -MAIL: ,fob Address (where the work is being done) _ City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Narne Phone # Contractor's Address City- - - - - -- - - State_ Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. OWNER BUILDER: Value of Work For this Permit S Type of Work: ❑ Addition / ❑ Alteration ! ❑New / ❑ Repair /Replace Describe Work Applir<ttion is hereby made to olviin a hermit to do the %work and installations as indicated. I certi fy that no work or installation has commenced prior to the issuance of a permit and that all woik will be peifoim°d to meet the standards ofall laws regulatingconstruction in this jurisdiction. I understand that a separate permit nursl he secured Ibr FLIV "I RICAl WORK. NJ SIGNS. WMI_S. POOLS, E'l1RNACRS, BOILFRS, I WATERS,TANKS and AIR CONDITIONh:RS, LTC.._. "WARNING TO OWNER: YOUR FAIL IRE TO RECORD A NOTICES OF CONINIf;NCEMENT MAY RESULT IN YOUR PAVING TNVICF. FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BUFORF RECORDING YOUR NOTICE OF CONINIENCENIENT." Notice lu ; I pplicool: .-I s a condition to the issuance of o huilding permit will) an eslinrated value exceeding 52500. the appliccurl rntrst promise in good froth Ihol o co/)v o the notice of comme ncement card construction Tien law brochure will be delivered to the person whose properly is szlfijecl to attachment. Also, a cerli ied c•ogv Qf the recorded notice q/ cornnreneemenl must he posted al the job sile %r the fb sl inspection which occurs seven (7) days after the building permit is issued M the absence of such posted notice. they inspection will not be approved and a reinspec•tion,fee will he charged. - ..r.i: >:xxrx::x #ri: >: x�c r.sFi:xxrr. icxri: xic 4c icxxi:xx�:xa:F is acxxk is ic��:xxxx Yet 4:xic *xic r.ici :icr. is :'<r. r. r. +`�: "r.xxxiexic�i: Permit Fee S CCF $ Technology Fee: Training /Education Fee S Notary S Code Enforcement $ Double Fee S Zoning S Total Fee Now Due S See Reverse side —> PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be fisted and indicate the color to be pain I� Directions: Please circle corresponding number to appropriate color sample. Walls: _ I - � — - Attach color samples with name jqd 4 number. Drip Cap /Drip 1 (2) 3 4 -- Roof: 1 ? 3 4 Floe -ver Mills 1 2 3 4 Shutters: l 2 3 4 Awnin 1 2 3 4 2 Chimney 2 3 4 Doors and Door Jams: I 3 4 Garage Doors: I 2 3 4 Railings I 2 3 4 3 Fences: I 2 3 4 All brick (simulated or re('ular 1 2 3 4 Stucco Banding: I 2 3 4 - j. La Any other Stucco Features: 1 2 3 4 . 4 Accessory Buildings Other: ,.. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with ail laws regulating construction and zoning. L' ` � Si Sig nature _ � T , . > g Owner or Agent , 1 Contractor It The foregoing instrument was acknowledged before me this - The foregoing instrument was acknowledged before me this day of c V14i( 2010 by /VCf `yn day of ,20 who is p ersonally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oat ". NOTARY PUBLIC: j- NOTARY PUBLIC: Sign: Sign: - - -- Print: Y41C`VY,4Vc?:T itsiL0 . G, "r1•e'1 N Print: My Commission Expires: i� i My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Preservation Board Notary Pub4ic State O P vu Margaret Mechele a 1 c� Code Enforcement 4 tgo Monmery My �rtnssion DDW351 (Revised 04/24/07) h c a Expires 0,6r21 /2010